Patients with severe mental illness are at an increased risk for developing cardiovascular disease and diabetes. Obesity, genetics, tobacco use, poor diet, and minimal physical activity further increase the risk of developing chronic metabolic and cardiovascular disease this patient population. People with major mental illness lose, on average, more than 25 years of potential life primarily as a result of developing chronic medical illnesses. It has been established that many atypical antipsychotics negatively affect weight, lipid profiles, and glucose tolerance in as little as ten days. In 2004, the American Diabetes Association (ADA), American Psychiatric Association (APA), and American Association of Clinical Endocrinologists (AACE) developed and published consensus guidelines for the use of antipsychotics. Because diagnosis of diabetes, hypertension, and hyperlipidemia remains underestimated and risperidone remains a first-line agents prescribed at James A. Lovell Federal Health Care Center (FHCC) we feel is important to evaluate our monitoring practices.

The rare, but potentially fatal, side effect of agranulocytosis has caused the use of clozapine to be regulated more than any other antipsychotic medication. All patients must be registered in the Clozapine National Registry and frequent monitoring of WBC (white blood cell) count and ANC (absolute neutrophil count) must be performed every 7-28 days depending on the current duration of treatment. According to the clozapine monitoring guidelines provided by the Clozapine National Registry, a WBC count less than 3000/mm³ or ANC less than 1500/mm³ requires interruption of clozapine therapy. However, some physicians and patients are reluctant to discontinue clozapine. There are limited published reports in which clozapine was continued and the neutropenia was managed by adding lithium or granulopoiesis stimulating factors (GSFs), changing concomitant medications that might also be implicated in neutropenia, or observing to see if neutropenia is transient.

Antipsychotics are associated with metabolic effects including increased body weight, cholesterol, and glucose. Patients with psychiatric disorders have also been found to have higher rates of cardiovascular disease and diabetes than the general population. This is thought to be attributed to undermonitoring and undertreatment of patients with psychiatric diseases. In 2004, the American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologist, and North American Association for the Study of Obesity released consensus guidelines (ADA/APA guidelines) for monitoring with second generation antipsychotics. Studies have shown low adherence to ADA/APA guidelines. Adherence to baseline glucose testing varies from 19-38.9%. Adherence to baseline lipid monitoring was found to be between 6-24.5%. In a single study, only 5% of patients had both baseline glucose and lipid testing.

About CPNP

The College of Psychiatric and Neurologic Pharmacists (CPNP) represents over 2,000 healthcare professionals.
As members of a treatment team of healthcare professionals,
psychiatric and neurologic pharmacists make a difference
in patient recovery and quality of life.